My oldest stayed home from school today due to a low-grade fever, a scratchy throat, and a mild cough. A number of her classmates currently have the same symptoms. It’s that time of year: cold-and-flu season, I thought this morning. It’s the time of year when much of the country starts lowering the storm windows and turning on the heat; ironically, here in southwest Florida, it’s the time of year when we start opening up the windows and turning off the air conditioner. But no matter where you live, there’s usually a cluster of respiratory illnesses in the autumn and winter. And I’m certain that nearly every parent has received the following call, or something similar, at one time or another from a worried-sounding school nurse:

Your child is here in my office and not feeling well. She has a headache and some body aches, along with a sore throat. I think she has the flu. Another student was just diagnosed with influenza A, so it’s going around the school, and given her symptoms, it’s likely that she also has it. We have a mandatory policy that students with the flu remain at home until they are completely well, and for a minimum of 5 days.

Who hasn’t heard an unfortunately ill friend or loved one announce that they “have the flu?” When I was seeing patients as a family doctor, it must have been one of the most frequent phrases uttered during the winter months…but from my standpoint as both a family doc and an immunologist, one of the most misunderstood.

Why? Because not all respiratory illnesses are actually “the flu.” Even when they look like “the flu.” Confused? You’re not alone.

Let’s look at “the flu” a bit more closely.

The syndrome, or collection of symptoms, commonly called “the flu” is caused by the influenza virus, of which there are three large groups, Types A, B, and C. Types A and B cause most of the influenza disease. Influenza virus is highly transmissible, passed by the spread of air-borne droplets from coughing or sneezing, directly through person-to-person contact, and indirectly through contact with contaminated surfaces. Not everyone who is infected will show symptoms, but when symptoms do appear, it’s typically within a day or two of infection.

Classically, the symptoms of influenza infection arise rapidly and can include high fever, muscle aches, headache, sore throat, dry cough, runny nose, and fatigue. Patients stop being infectious within about 24 hours after the fever disappears. When you consider that these symptoms are often shared by the common cold, it’s easy to see why there’s so much confusion. But an experienced clinician can usually tell whether a patient’s symptoms are more likely to represent “the flu” or a garden-variety cold.

But even when it looks like “the flu,” it’s impossible to tell for sure without laboratory tests. A great number of other viruses and bacteria can cause respiratory illnesses clinically indistinguishable from that of influenza. True influenza accounts for only a fraction of everything which looks like “the flu.”

Then should everyone be tested? Should everyone be treated? The answer to both questions is no, because fortunately, the vast majority of patients will get better without any intervention.

Like the common cold, influenza is typically self-limited, with symptoms usually resolving in about a week in healthy children and adults. Anti-viral medications used for influenza won’t work well for influenza-like illness caused by other microbes, and they’re usually reserved for individuals at risk or those who have severe disease or complications. Those at risk include the very young and the very old, those with weakened immune systems, and those with chronic conditions which can interfere with the body’s ability to heal itself, such as diabetes, cardiovascular disease, liver disease, kidney disease, and sickle cell anemia. Your healthcare provider can determine whether influenza testing and anti-viral treatment are warranted.

As we head into cold-and-flu season, it’s wise to remember that “an ounce of prevention is worth a pound of cure.” (I’m going to ignore the annual flu vaccine here because, at this time, there is a good deal of debate over its true benefits.) One of the best low-tech preventive strategies is thorough and frequent handwashing using plain soap and water; antimicrobial preparations aren’t necessary. Sneeze or cough into a tissue or the inside crook of your elbow to avoid spreading infections to others. Maintain your reserves and keep your immune system in tip-top shape by getting plenty of rest, eating healthily, exercising, and spending lots of time in the fresh air.

Influenza is just one microbe which can interfere in the life and work of a voice actor…or anyone else, for that matter. At times, no matter how well we take care of ourselves, many of us wind up getting sick…usually with something not too serious, thank goodness. In a future entry, I’ll address strategies for dealing with common respiratory illness.

Here are some resources regarding influenza which you may find helpful: